The importance of professional boundaries 

When forming and recruiting for a client’s care package, it is critical to ensure that clear expectations and boundaries are set for the relationship that will exist between clients/the employer and their team. From my own experience of recruiting a care team for my sister Katie who has an acquired brain injury, unclear expectations can lead to blurred boundaries, misunderstandings and upset that can ultimately lead to the breakdown of the relationship between clients and their carers and, in the worst case, may lead to the necessity to remove employees from a client’s care team altogether - resulting in interruptions to or the diminishment of the client’s support and possible exposure to onerous and costly employment claims (we have seen instances of claims being successfully brought against clients  as the consequence of incidents leading to dismissal). 

It is widely recognised that it is particularly challenging for care workers working in clients’ own homes to maintain clear professional boundaries and that breaches frequently begin in a seemingly small or trivial way and often in circumstances where carers believe that they are acting in good faith and with the client’s interests at heart – for example, in cases where employees maintain communication with their client outside of work/via social media, or treating clients to small gifts that they couldn’t otherwise afford. 

However, even small breaches can lead to negative consequences including the client building unrealistic expectations of their team, becoming increasingly dependent upon individual carers which can lead to disempowerment of the client as well as attachment - which can result in tension in the relationship and place undue pressure on employees and the team (Cooper, 2012). 

It is essential to agree the expectations of carers during the formation of clients’ care packages and a behaviour agreement which the client signs up to can be a useful tool when used in conjunction with specific professional boundaries training for employees which should be delivered as part of their induction, reiterated in documents including the employee handbook and reinforced during supervision and team meetings. Carers should know how and when to escalate any case where they are concerned or believe that professional boundaries have been, or are likely, to be breached so that prompt action can be taken to avoid untoward consequences and so ensure that the relationship can be ‘reset’ before it breaks down irretrievably. 

A professional Case Manager can assist the development of a Behaviour Agreement as part of their broader range of services and the engagement of a specialist, Care Quality Commission regulated care provider such as Superior Healthcare (particularly in the case of large care teams or fluctuating support needs) can take away many of the challenges faced in direct employment - including supporting the delivery of an effective training and supervision programme as well as providing ongoing management of the relationship between clients and their care team to ensure the optimal outcome for the person who is being supported.

If you would like to discuss the importance of professional boundaries and how we can support you to achieve a professional care arrangement for your relative or client, please do not hesitate to contact Richard Thorp of Circle Case Management or Stewart Thorp of Superior Healthcare.  More details can be found at www.circlecasemanagement.com and www.superiorhealthcare.co.uk.  

Richard Thorp

Managing Director, Circle Case Management 

T: 01297 529718

E: hello@circlecm.com

Stewart Thorp 

CEO, Superior Healthcare 

T: 01227 771133 

E: StewartThorp@superiorhealthcare.co.uk  

References: 

Cooper, F (2012). Boundaries in Social Work and Social Care. London: Jessica Kingsley Publishers. p131-139.